Antimicrobial labelling in Australia: a threat to antimicrobial stewardship?
Abstract: Antimicrobial resistance is a public health emergency, placing veterinary antimicrobial use under growing scrutiny. Antimicrobial stewardship, through appropriate use of antimicrobials, is a response to this threat. The need for antimicrobial stewardship in Australian veterinary practices has had limited investigation. A 2016 survey undertaken to investigate antimicrobial usage patterns by Australian veterinarians found that antimicrobial dose rates were varied and often inappropriate. Doses of procaine penicillin in horses and cattle were often low, with 68% and 90% of respondents, respectively, reporting doses that were unlikely to result in plasma concentrations above minimum inhibitory concentrations for common equine and bovine pathogens. Frequency of penicillin administration was also often inappropriate. Gentamicin doses in horses were largely appropriate (89% of dose rates appropriate), but 9% of respondents reported twice daily dosing. Amoxycillin and amoxycillin-clavulanate were administered at the appropriate doses, or above, to dogs and cats by 54% and 70% of respondents, respectively. Here, we explore the potential reasons for inappropriate antimicrobial dose regimens and report that antimicrobial labels often recommend incorrect dose rates and thus may be contributing to poor prescribing practices. Changes to legislation are needed to ensure that antimicrobial drug labels are regularly updated to reflect the dose needed to effectively and safely treat common veterinary pathogens. This will be especially true if changes in legislation restrict antimicrobial use by veterinarians to the uses and doses specified on the label, thus hampering the current momentum towards improved antimicrobial stewardship.
© 2018 Australian Veterinary Association.
Publication Date: 2018-04-25 PubMed ID: 29691852DOI: 10.1111/avj.12677Google Scholar: Lookup
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- Journal Article
Summary
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This research explores the use of antimicrobials in Australian veterinary practices and the potential contributing factors to improper dosing, highlighting the need for improved antimicrobial stewardship and changes in legislation to ensure accurate drug labelling.
Background
- Antimicrobial resistance is a global health crisis, with veterinary antimicrobial use increasingly being scrutinised.
- Antimicrobial stewardship, which involves the correct and responsible use of antimicrobials, has emerged as a solution to this issue.
- The need for such stewardship in Australian veterinary practices has not been thoroughly investigated, leading to this study.
Study Findings
- The researchers surveyed Australian veterinarians in 2016 to investigate their patterns of antimicrobial usage.
- The survey results revealed varied and often inappropriate antimicrobial dosages. For example, doses of procaine penicillin in horses and cattle were often low, with 68% and 90% respondents, respectively, using doses unlikely to result in effective plasma concentrations.
- Penicillin was also often improperly administered often, adding to the inappropriate use.
- While most veterinarians were found to administer proper dosages of gentamicin in horses (89%), a small but significant number (9%) reported administering it twice a day, which is not the recommended frequency.
- More positively, amoxicillin and amoxicillin-clavulanate were found to be administered at or above the recommended dosages to dogs and cats by 54% and 70% of respondents, respectively.
Reasons for Inappropriate Dosing
- The authors propose that one major factor contributing to improper antimicrobial dosing may be inaccurate antimicrobial labels.
- These labels often recommend incorrect dose rates, potentially leading to poor prescribing practices among veterinarians.
Legislation Changes
- To combat this issue, the authors advocate for changes in legislation to ensure regular updates to antimicrobial drug labels.
- These updates should accurately reflect the dosages needed to treat common veterinary pathogens effectively and safely.
- Such legislation changes will be particularly important if future laws restrict veterinarians to only the uses and doses specified on the antimicrobial labels.
- This adjustment could otherwise potentially slow the current momentum towards improved antimicrobial stewardship.
Cite This Article
APA
Hardefeldt LY, Gilkerson JR, Billman-Jacobe H, Stevenson MA, Thursky K, Browning GF, Bailey KE.
(2018).
Antimicrobial labelling in Australia: a threat to antimicrobial stewardship?
Aust Vet J, 96(5), 151-154.
https://doi.org/10.1111/avj.12677 Publication
Researcher Affiliations
- Asia-Pacific Centre for Animal Health, Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Parkville, Victoria, Australia.
- National Centre for Antimicrobial Stewardship, Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Parkville, VIC, Australia.
- Asia-Pacific Centre for Animal Health, Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Parkville, Victoria, Australia.
- National Centre for Antimicrobial Stewardship, Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Parkville, VIC, Australia.
- Asia-Pacific Centre for Animal Health, Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Parkville, Victoria, Australia.
- National Centre for Antimicrobial Stewardship, Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Parkville, VIC, Australia.
- Asia-Pacific Centre for Animal Health, Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Parkville, Victoria, Australia.
- National Centre for Antimicrobial Stewardship, Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Parkville, VIC, Australia.
- National Centre for Antimicrobial Stewardship, Peter Doherty Institute, Carlton, VIC, Australia.
- Asia-Pacific Centre for Animal Health, Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Parkville, Victoria, Australia.
- National Centre for Antimicrobial Stewardship, Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Parkville, VIC, Australia.
- Asia-Pacific Centre for Animal Health, Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Parkville, Victoria, Australia.
- National Centre for Antimicrobial Stewardship, Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Parkville, VIC, Australia.
MeSH Terms
- Animals
- Anti-Bacterial Agents / administration & dosage
- Anti-Bacterial Agents / therapeutic use
- Antimicrobial Stewardship
- Australia
- Cattle
- Drug Labeling
- Drug Utilization
- Horses
- Prescription Drug Misuse / statistics & numerical data
- Surveys and Questionnaires
- Veterinarians
Citations
This article has been cited 8 times.- Sri A, Bailey KE, Gilkerson JR, Browning GF, Hardefeldt LY. Attitudes towards Use of High-Importance Antimicrobials-A Cross-Sectional Study of Australian Veterinarians. Antibiotics (Basel) 2022 Nov 10;11(11).
- Ludbey PA, Sahibzada S, Annandale CH, Robertson ID, Waichigo FK, Tufail MS, Valenzuela JL, Aleri JW. A pilot study on bacterial isolates associated with purulent vaginal discharge in dairy cows in the south-west region of Western Australia. Aust Vet J 2022 May;100(5):205-212.
- Hur B, Hardefeldt LY, Verspoor KM, Baldwin T, Gilkerson JR. Evaluating the dose, indication and agreement with guidelines of antimicrobial use in companion animal practice with natural language processing. JAC Antimicrob Resist 2022 Mar;4(1):dlab194.
- Fujimoto K, Kawasaki M, Abe R, Yokoyama T, Haga T, Sugiura K. Establishing defined daily doses (DDDs) for antimicrobial agents used in pigs, cattle and poultry in Japan and comparing them with European DDD values. PLoS One 2021;16(4):e0245105.
- Redpath A, Hallowell GD, Bowen IM. Use of aminoglycoside antibiotics in equine clinical practice; a questionnaire-based study of current use. Vet Med Sci 2021 Mar;7(2):279-288.
- Norris JM, Zhuo A, Govendir M, Rowbotham SJ, Labbate M, Degeling C, Gilbert GL, Dominey-Howes D, Ward MP. Factors influencing the behaviour and perceptions of Australian veterinarians towards antibiotic use and antimicrobial resistance. PLoS One 2019;14(10):e0223534.
- Wyrsch ER, Hawkey J, Judd LM, Haites R, Holt KE, Djordjevic SP, Billman-Jacobe H. Z/I1 Hybrid Virulence Plasmids Carrying Antimicrobial Resistance genes in S. Typhimurium from Australian Food Animal Production. Microorganisms 2019 Aug 29;7(9).
- Ekakoro JE, Caldwell M, Strand EB, Okafor CC. Drivers of Antimicrobial Use Practices among Tennessee Dairy Cattle Producers. Vet Med Int 2018;2018:1836836.
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